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TjlE  I^ELi^TIOpl  OF  TflE  DEjlTAL  QI(^AW^  TO  0U1(HEJ\LTH. 


BY 


CHARLES  G.  PEASE,  M.  D.,  D.  D.  S. 


Professor  of  Oral  Surgery  in  the  Metropolitan  Post  Graduate  School  of  Medicine. 
Late  Lecturer  on  Materia  Medica,  Therapeutics  and  Pathology  in  the  New  York 
Dental  School.    Consulting  Oral  Surgeon  to  the  Five  Points  House  of  Industry 
Hospital.   Honorary  Dipioniate  in  Anaestliesia  and  AnEBSthetics  of  tlie  Phila. 
Dental  College  and  in  General  Surgery  of  the  Medico-Chirurgical  Col- 
lege a  ud  Hospital  of  Philadelphia.    Honorary  Member  of  La  Societe 
Francaise  d'  Electrotherapie  of  Paris,  France.     Member  of  the 
New  York  State   Horn.    Medical  Society,  New  York  County 
Horn.  Medical  Society,  American  Institute  of  Homoeopatliy," 
Academy  of  Pathological  Science,  Hahnemann  Associ- 
ation, New  Y'ork  Materia  Medica  Society,  First 
District  Dental  Society  of  the  State  of  New 
Y'ork,  National  Society  of  Electrotherapeu- 
tists,  Alumni  Associatiiin  of  Pliila. Dent- 
al College,  Alumni  Association  of 
New  Y''ork  Hom.  Medical  College 
and  Hospital,  Etc.,  Etc. 


PUBLISHED  FOR  THE  BENEFIT  OF  THE  LAITY. 


NEW    YORK : 

KOERICKE,    RUNYON   &  ERNESTY, 

1895. 


Entered  according:  to  act  of  Congress,  in  the  year  1895, 

BY  THE  AUTHOR, 

In  tlie  office  of  the  Librarian  of  Congress, 

at  Washington. 


I  dedicate  these  pages  of  abridged  instruction 

to  uiy  comrades 

of  Coiupany  B,  7th  Regiment 

N.  G.  S.  N.  Y. 


PREFACE. 

Realizing  that  the  average  reader  will  not  wade  through 
matter  that,  to  the  unprofessional  is  dry  and  uninteresting,  yet 
nevertheless  important,  the  Author  has  endeavored,  in  as  few 
words  as  possible,  to  give  the  instruction  essential  to  success  in 
the  care  of  the  teeth  and  surrounding  tissues,  of  which  the  laity 
are  largely  in  ignorance. 

Prophylaxis  is  far  preferable  to  remedial  effort,  and  with  the 
consciousness  that  Caries  is  the  gateway  not  only  to  the  de- 
struction of  the  tcoth,  but  to  all  the  pains  and  aches  concomit- 
ant with  pulp  irritation  and  congestion  and  pericementitis  and 
alveolar  abscess  as  a  sequence  of  caries,  we  should  avail  our- 
selves of  the  knowledge  that  will  not  only  aid  us  in  preserving 
the  integrity  of  the  tooth,  but  the  exercise  of  which  will  prevent 
suffering  and  save  much  expense,  to  sa)''  nothing  of  the  comfort, 
the  appearance  and  the  maintenance  of  the  health  through  the 
preservation  of  unbroken  arches,  superior  and  inferior  (upper 
and  lower)  which,  with  proper  occlusion  affords  perfect  masti- 
cating powers.  If  the  suggestions  contained  ih  these  pages 
will  awaken  an  interest  in  the  reader,  looking  to  their  applica- 
tion and  to  a  further  and  fuller  study  of  the  subjects,  the  work 
will  not  have  failed  in  its  object. 

THE   AUTHOR. 
101  West  ;2d  Street. 


Digitized  by  tine  Internet  Archive 

in  2010  witin  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/hintssuggestionsOOpeas 


THEORY    OF    CARIES. 

The  causes  of  disease  presents  the  most  interesting-,  and  yet 
difficult  lines  of  research  in  medical  science. 

The  accepted  theory  of  decay  is,  that  of  the  action  of  an  acid 
the  product  of  micro-organisms  during  the  phenomena  of  fer- 
mentation, the  acid  dissolving  out  the  lime  salts  of  the  tooth  at 
point  of  contact,  exposing  the  organic  matter,  which,  being- 
acted  upon  by  the  ferment,  continues  the  phenomena. 

Alimentary  particles  allowed  to  remain  about  and  between 
the  teeth,  subject  to  the  conditions  of  heat,  moisture  and  air; 
the  three  requisites  for  decomposition,  often  aided  by  vitiated 
fluids  of  the  mouth,  undergo  fermentation  and  we  have  as  a 
result  the  production  of  the  acid  referred  to.  There  are  many 
interesting  experiments  under  this  head. 

Dr.  Margitot  of  Paris,  placed  sound  teeth  into  a  solution  of 
sugar,  one  part  sugar  to  three  of  water,  and  allowed  the  sol- 
ution to  undergo  the  process  of  fermentation.  At  the  end  of  two 
years  the  solution  was  found  to  be  markedly  acid,  and  the 
teeth  completely  decalcified.  The  teeth  which  had  been 
protected  by  wax  at  all  but  one  point  were  also  decal- 
cified, but  at  the  point  of  exposure  there  was  a  localized  cavity 
having  all  the  characteristics  of  caries.  In  another  solution  of 
sugar,  glucose  was  added  and  a  few  drops  of  creosote  to  pre- 
vent fermentation.  The  teeth  were  placed  in  the  solution  as 
before,  and  allowed  to  remain  for  two  years.  Fermentation 
was  prevented,  and  none  of  the  teeth  showed  any  alteration 
whatever.  Experiments  were  also  made  which  consisted  in  a 
systematic  observation  of  human  teeth,  prepared  and  mounted 
on  natural  roots,  as  pivot  teeth.  After  some  years'  wear,  in 
mouths  in  which  caries  was  actively  progressive  in  the  remain- 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


ing-  natural  teeth,  the  substituted  teeth  were  affected  with 
caries  in  the  same  manner  as  the  natural  organs.  The  cavities 
were  of  the  same  form  and  of  the  same  appearance  as  those  in 
the  natural  organs,  and  in  the  same  position,  and  the  contents 
gave  the  same  acid  reaction.  There  can  be  no  question,  there- 
fore, that  an  agent  is  acting  from  without  and  is  independent 
of  the  vitality  of  the  tooth  attacked ;  but  soft  teeth,  teeth  of 
poor  qualit}^  will  yield  more  quickl}-  than  those  of  dense 
structure  In  the  young  we  find  the  new  teeth  more  or  less 
soft,  due  to  the  fact  that  there  is  still  much  protoplasm  in  their 
structure,  calcification  not  being  completed. 

DISINTEGRATION  OF  TEETH  IN  EARLY 
MOTHERHOOD. 

Remedy  lies  in  a  knowledge  of  the  systemic  and  local  forces 
at  work  during  gestation,  inimical  to  tooth  structure"*  and  the 
application  of  the  indicated  remedies. 

Thorough  cleanliness  and  an  antacid  mouth  wash  used  fre- 
quently and  thoroughly  (three  or  four  times  daily,)  together 
with  systemic  treatment,  will  do  much  to  successfully  bridge 
this  period.  It  is  a  lamentable  fact  that  destruction  of  teeth 
has  been,  and  is  now,  permitted  during  this  time  throiigh  lack 
of  knowledge. 

The  teeth  become  less  resistant  owing  to  a  loss  in  lime  salts. 
The  disturbance  of  the  circulation,  nervous  irritation,  and  the 
new  formative  process,  causing  a  dissolving  of  a  portion  of 
the  lime  salts  in  the  ossius  structure  of  the  body,  which  are 
taken  up  and  held  in  solution  by  the  blood.  The  saliva  is  acid 
in  reaction,  and  the  gastric  phenomena  are  equally  unfavorable 
to  the  well  being  of  the  teeth,   which  are  greatly  jeopardized 

♦"Prophylactic  Treatment  of  the  Diseases  of  the  Dental  Organs,"  by  the  Author, 
read  before  the  New  York  County  Homojopathic  Medical  Society,  February,  1893,  and 
published  in  the  North  American  Journal  of  Homceopathy,  May  1893. 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


by  the  local  fermentative  and  acid  condition,   plus  their  tem- 
porarily weakened  structure. 

After  gestation  and  nursing,  the  lime  salts  are  redeposited 
in  the  bone  and  teeth  tissue,  restoring  their  former  density. 
Therefore  if  the  teeth  are  protected  during  this  period  from 
the  inroads  of  caries,  they  again  become  strong  and  resisting, 
and  are  preserved  unimpaired,  or  with  slight  damage,  for 
years  of  usefulness. 

LOCAL  CONDITIONS  FAVORING  DECAY. 

Acid '  conditions  of  the  oral  cavity.  Extreme  thermal 
changes  as  in  the  use  of  very  cold  or  very  hot  food  or  drinks. 
Irregularity  of  teeth  by  affording  lodgment  for  food,  and  pre- 
venting proper  cleansing.  Flap  of  tissue  lying  over  wisdom 
teeth  which  retains  particles  of  food  in  contact  with  them. 
A  glairy  and  tenacious  mucus  in  the  mouth,  an  expression  of 
super-alkalinity  of  the  blood.  Covering  the  teeth  as  a  film, 
preventing  perfect  cleansing  of  them,  and  requiring  systemic 
treatment.  Local  irritation  of  the  margin  of  the  gums  causing 
marked  acid  conditions  of  the  mucus  exuded.  Improperly  ad- 
justed clasps  or  other  dental  appliance.  Filling  material, 
placed  in  cavities,  that  is  not  compatible  with  the  structure  or 
quality  of  the  teeth.  The  use  of  medicines  injurious  to  tooth 
structure,  etc.,  are  some  of  the  local  conditions  favoring  decay. 

SYSTEMIC  CONDITIONS  PREDISPOSING 
TO  DECAY. 

Lack  of  lime  salts  in  the  system,  or  a  lack  of  physiological 
ability  to  appropriate  them  and  btiild  them  in  properly  with 
the  organic  matter  of  the  teeth,  will  produce  a  weak  structure, 
which  will  fall  a  more  easy  prey  to  unfavorable  local  con- 
ditions.     The  constitution  of  parents,   especially  the  mother. 


CARE    AND    PRESERVATION    OF    THE    TEETH. 


may  have  been  unable  to  impart  due  vigor  or  proper  materials, 
in  requisite  quantities,  to  the  process  of  developing  the  bone 
and  teeth.  "  If  our  young  females  have  hitherto  been  deprived 
of  the  necessary  constituents  for  the  full  development  of  the 
body,  can  we  wonder  that  a  woman  should  be  the  delicate  and 
fragile  being  she  so  often  is,  or  that  by  the  decay,  which  as- 
sails the  teeth  in  early  life,  she  should  be  robbed  of  an  orna- 
ment of  so  great  value?  " 

If  this  condition  of  things  can  be  changed,  if  the  physical 
constitution  of  women  can  be  saved  from  further  degeneracy, 
we  may  hope  for  a  more  hardy  and  vigorous  race  of  men ;  for 
it  is  to  the  healthy  and  vigorous  constitution  of  woman  that  we 
must  look  for  such  results.  Dr.  James  E.  Garretson  lays  great 
stress  upon  this  subject  in  his  work  on  Oral  Surgery.  The 
forces  of  life  are  controlled  and  governed  by  the  sympathetic 
system  of  nerves.  Deplete  or  exhaust  this  system  of  nerve 
supply  and  you  have  a  weakened  constitution.  Impoverished 
system,  poorly  nourished  tissues. 

Is  there  a  waste  of  the  sympathetic  nerve  system  going  on 
in  many  individuals  undiscovered  and  unrecognized?  Yes,  and 
the  source  of  this  waste  or  the  cause  of  the  depletion  of  this 
life  force  in  many  cases  has  lately  been  discovered  by  E.  H. 
Pratt,  M.  D.  of  Chicago,  111.  who  claims  not  the  glory  thereof 
for  himself  but  for  the  God  who  gave  the  inspiration.  The 
doctor  claims  to  stand  as  but  the  exponent  of  a  thought.  The 
Author  wishes  here  to  express  his  indebtedness  for  the  pleas- 
ure and  very  great  profit  obtained  through  and  by  his  meetings 
and  intercourse  with  Dr.  Pratt.  The  pathological  conditions 
often  existing  in  and  about  the  pelvic  region  both  in  the  young 
and  the  old  wholly  unsought  for  and  in  the  large  per  cent,  of 
cases  unrecognized  if  found,  is  the  cause  of  not  only  weakened 
constitutions  but  in  many  cases  of  nervo  and  nervo-epleptic 

conditions. 

The  first  tissues  to  be  nourished  is  the  skin,  the  bones  later 
and  last  of  all  the  brain  and  spinal  cord. 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


It.  is  of  the  utmost  importance  that  every  avenue  of  waste 
should  be  discovered  and  the  fault  corrected. 

The  blood  stream  carries  the  pabulum  from  and  by  which 
the  tissues  are  nourished  and  built.  This  is  brought  in  contact 
with  the  tissues  by  the  capillaries. 

To  stimulate  the  flushing  of  the  capillaries  is  therefore  im- 
perative for  the  health  and  nutrition  of  the  tissues.  Be  this 
accomplished  as  it  may.  We  see  restoration  to  health  through 
mental  influences  resulting  in  the  flushing  of  the  capillaries. 
Certain  dilalations  will  produce  like  flushing  of  capillaries  with 
like  result  in  a  marked  degree  other  conditions  being  favorable. 
Remedies  also  have  their  place.  .  This  is  a  great  subject  and 
can  but  be  touched  upon  here. 

In  dyscrasia  causing  a  perversion  of  the  secretion  of  the 
mucus  glands,  acting  locally  as  a  cause  of  decay. 

In  gestation,  nervous  prostration.  Typhoid  conditions,  &c., 
we  have  a  temporary  weakening  of  the  tooth  structure,  requir- 
ing more  rigid  hygienic  and  prophylactic  measures  to  protect 
the  teeth  during  these  conditions. 

USE  OF  THE  TOOTH  BRUSH. 

The  festooning  at  the  margin  of  the  gums  over  each  tooth, 
which  in  beauty  is  to  the  tooth  as  is  a  handsome  setting  to 
a  gem,  is  usually  ruined  by  ruthlessly  scrubbing  the  teeth 
back  and  forth,  irritating  the  gums  and  causing  them  to  recede, 
at  the  same  time  the  food  is  forced  between  the  teeth  by  this 
character  of  brushing.  The  teeth  should  be  rather  wiped  with 
the  brush  in  direction  from  the  necks  to  the  cutting  edges, 
or  masticating  surfaces,  on  inner  and  outer  faces,  allowing  the 
bristles  to  pass  between  the  teeth  carrying  out  the  alimentary 
particles  that  may  have  lodged  between  them.  Never  brush 
toward  or  against  the  gum.  Brush  hard  on  the  masticating 
surfaces  of  the  molars  and  bicuspids  to  clear  the  sulci  or 
depressions  of  all  food  particles  which  settle  in  them,  as  these 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


are  the  weakest  points  of  the  tooth.  These  suggestions  cannot 
be  too  closely  followed.  Although  the  Author  in  his  practice 
impresses  the  importance  of  them  upon  his  patients,  some  are 
too  forgetful  of  their  value. 

CHOICE  OF  A  BRUSH.     . 

The  brush  should  be  small  and  not  too  harsh.  A  child's 
brush  is  preferable  to  the  large  unwieldy  ones  placed  on  the 
market  for  adults.  They  cannot  be  used  without  damaging 
the  gums.  Those  with  long  bristles  at  the  end  are  to  be  es- 
pecially avoided  for  this  reason.  If  a  brush  is  too  harsh  keep 
it  moist. 

FLOSS  SILK. 

This  should  be  passed  between  the  teeth  frequently  and  at 
least  once  a  day  preferably  at  night,  to  relieve  them  of  alimen- 
tary particles  not  reached  by  the  brush  and  to  polish  the  ap- 
proximal  surfaces,  making  them  in  a  measure  self -cleansing. 
The  waxed  silk  is  preferable. 

THE  TOOTH  PICK. 

The  wooden  tooth-pick  is  well  adapted  for  the  purpose  ex- 
cept that  it  is  liable  to  be  broken  off  between  the  teeth.  For 
that  reason  the  quill  is  preferable.  Metal  toothpicks  should 
not  be  used.  Care  should  be  exercised  not  to  wound  or  irri- 
tate the  gums  between  the  teeth  as  it  causes  them  to  recede 
and  form  pockets  affording  additional  space  for  the  lodgment 
of  food  which  is  then  more  difficult  to  dislodge.  Floss  silk  af- 
fords the  safest  means  of  freeing  the  spaces  between  the  teeth. 


CARE  AND  PRESERVATION  OF  THE  TEETH.  13 

DENTIFRICE. 

An  appropriate  dentifrice  should  be  used  once  a  day  prefer- 
ably after  breakfast,  as  prior  to  this  meal  the  teeth  do  not 
require  its  use,  a  mouth-wash  answering  every  purpose,  the 
teeth  having  been  cleansed  the  previous  night  before  retiring. 
The  preparations  placed  upon  the  market  the  formulae  of  which 
are  not  known  should  be  avoided.  The  practitioner  should 
furnish  his  patient  with  a  good  article  or  a  recipe  for  the  same. 
The  Author  refers  the  reader  to  the  formulae  appended. 

MOUTH  WASH. 

A  wash  should  be  used  to  more  thoroughly  sweeten  and 
cleanse  the  mouth.  Its  properties  should  be  antiseptic,  ant- 
acid, detergent,  and  slightly  astringent,  and  should  be  used  in 
the  morning,  and  after  meals.  At  night  a  markedly  antacid 
wash  should  be  thoroughly  used  just  before  retiring  as  an  ad- 
junct to  the  brush.  It  is  of  great  importance  and  a  faithful 
observance  of  this  injunction  will  bring  its  reward  in  protecting 
the  teeth  from  the  inroads  of  caries,  by  neutralizing  the  acid 
of  fermentation  which  is  active  in  the  mouth  during  the  sleep- 
ing hours.  A  solution  of  bicarbonate  of  soda  ten  grains  to  the 
ounce  of  water,  is  a  good  wash  for  use  at  night,  or  the  milk  of 
magnesia  referred  to  under  "  Erosion  of  Teeth." 

EXAMINATION  OF  TEETH. 

The  required  frequency  of  examinations  depends  upon  the 
age  of  the  patient  and  quality  of  tooth  structure.  Examina- 
tions at  the  office  of  the  practitioner  are  of  great  importance, 
permitting  of  the  detection  of  cavities  of  decay,  while  yet  small, 
timely  insertions  of  fillings,  or  making  of  application,  to  check 
the  decay.     Preserving  the  pulp,  the  dentinal  structure  and  ad- 


14  CARE  AND  PRESERVATION  OF  THE  TEETH. 

jacent  parts  in  a  condition  of  health  and  integrity. 

Examinations  should  be  made  (as  to  frequency)  as  follows: 
Between  2^  and  6  years,  every  1  to  3  months. 
6  and  14       "  "      3  to  6 

After  the  ag-e  of  14  years,  every  six  months  to  a  year. 

THE  GLASS  TUBE. 

Which  is  used  so  largely  in  taking  medicines  hurtful  to  the 
teeth,  is  not  the  protection  it  is  thought  to  be.  The  tongue  is 
placed  against  the  roof  of  the  mouth,  the  center  of  the  tongue 
is  then  depressed,  which  forms  a  vacuum  causing  the  liquid  to 
flow,  through  the  little  trough  formed  at  the  tip  of  the  tongue, 
into  the  cavity  of  the  vacuum,  the  center  of  the  tongue  is  again 
pressed  against  the  roof  of  the  mouth  forcing  the  liquid  into 
the  pharjmx,  in  the  act  of  swallowing ;  and  a  proportion  of  the 
liquid  will  ooze  out  on  either  side  of  the  tongue  and  come  in 
contact  with  the  teeth.  An  alkaline  wash  should  always  be 
Tised  immediately  after  each  dose  of  iron  or  acid  remedy  or 
drinks. 

HYGIENE. 

The  importance  of  perfect  cleanliness  cannot  be  too  strongly 
emphasized.  "  The  teeth  are  a  trouble  from  the  cradle  to  the 
grave,"  some  one  declares.  But,  it  seems  ridiculous  that, 
while  we  never  think  of  grumbling  because  our  hair  and  our 
nails  need  regular  attention,  we  look  upon  every  atom  of  care 
devoted  to  the  teeth  as  something  superfluors  and  burdensome. 
We  understand  the  social  advantages  of  a  pretty  mouth,  which 
is  largely  dependent  upon  teeth  that  are  faultless  in  contour 
and  arrangement;  and  we  certainly  realize  that  health  and 
comfort  result  from  a  perfect  denture.  But  it  is  a  fact  we  like 
to  keep  in  the  background  of  our  minds.  We  owe  it  to  our 
children,   however,   even  if  we  have  not  learned  to  practice  it 


CARE  AND  PRESERVATION  OF  THE  TEETH.  15 

for  ourselves,  to  make  the  care  of  the  teeth  a  regular  habit 
with  them,  for  the  lack  of  perfect  cleanliness  is  a  great  factor 
in  their  decay.  There  is  no  period  during  the  twenty-four 
hours  in  which  perfect  cleanliness  is  more  essential  than  the 
hours  spent  in  sleep.  The  mouth  is  then  quiet  and  the  saliva 
does  not  flow;  consequently,  there  is  nothing  to  reduce  the 
acidulated  conditions,  due  to  the  fermentations  of  particles  of 
food  allowed  to  remain  between  the  teeth  and  about  the  mouth. 
Think  of  it!  every  uncleansed  mouth  is  a  distillery  for  the  mak- 
ing of  poison,  and  yet  we  submit  to  this  going  on  all  night 
rather  than  go  to  the  trouble  to  brush  our  teeth  before  going 
to  sleep! 

Parents  do  not  realize  their  great  responsibility  in  this  direc- 
tion and  the  burden  their  lack  of  knowledge  and  thoughtful- 
ness  inflicts  upon  their  children.  A  baby's  mouth  should  be 
cleansed  for  him,  and  as  soon  as  he  is  able  to  understand,  the 
importance  of  caring  for  his  own  teeth  should  be  impressed 
upon  him. 

Unless  we  make  our  children  appreciate  the  benefits  to  be 
derived  from  a  perfect  denture,  and  the  evils  resulting  from  a 
marred  and  imperfect  one,  it  will  be  impossible  to  secure  for 
these  important  factors  of  our  healthy  existence,  the  care 
necessary  to  preserve  them.  Parents  ought  not  to  feel  it  a  tax 
upon  them  to  make  their  children's  teeth  a  subject  of  watchful 
and  intelligent  management. 

During  illness  when  the  teeth  are  in  the  most  jeopardized 
condition  and  the  ability  of  the  patient  to  care  for  them  de- 
creased, a  wash  should  be  employed  that  will  meet  the  con- 
ditions and  give  relief  without  undue  exertion  on  the  part  of 
the  patient.  To  this  end  the  nurse  with  brush  and  syringe  can 
accomplish  that  which  might  otherwise  be  tiring  to  the  patient. 

If  more  care  were  expended  in  this  direction  we  should  not 
meet  the  many  dental  wrecks,  dating  from  the  first  motherhood 
or  some  prolonged  illness. 


1 6  CARE    AND    PRESERVATION    OF    THE    TEETH. 

PHYSICAL  EXERCISE. 

Healthful  outdoor  exercise  and  plenty  of  it  is  necessary  if  we 
wish  a  strong  vigorous  constitution  for  ourselves  and  our  off- 
spring. The  forces  of  life  and  nutrition  are  sluggish  in  those 
who  recline  in  doors,  and  who  lack  proper  exercise  in  the  open 
air.  The  lime  salts  are  not  properly  appropriated  by  the  bone 
tissue.  The  vital  organs  do  not  rightly  perform  their  functions. 
Therefore,  how  important  is  it  that  we  give  more  attention  to 
our  mode  of  living.  In  city  life  the  incentive  to  outdoor  exer- 
cise is  limited.  Consequently  we  should  create  opportunity  in 
that  direction  through  the  various  avenues  open  to  us. 

Passive  outing  is  of  benefit,  but  in  health  we  require  that 
exercise  which  brings  into  active  play  the  muscular  system, 
giving  strength  and  vigor  to  the  tissues,  oxygenating  the  blood 
and  strengthening  the  lungs  through  deep  inhalations,  stimu- 
ulating  the  vital  organs  to  physiological  action  and  bringing 
the  health  glow  to  the  cheek.  As  aids  to  indoor  exercise  and 
physical  development,  the  dumb-bells,  clubs,  boxing-gloves, 
foils,  and  other  appliances  are  of  importance.  Proper  and  free 
ventilation  of  the  room  is  requisite  during  exercise.  Draughts 
should  be  avoided  and  a  vigorous  after  rub-down,  is  strongly 
recommended. 

When  the  system  has  been  depleted  by  illness,  muscular  ex- 
ercise by  the  means  of  massage  is  helpful. 

For  the  best  physical  results  regular  habits  should  be  main- 
tained and  the  hours  of  sleep  sufficient  to  the  demands  of  the 
individual.  A  healthy  mind  as  well  as  strong  teeth  are  con- 
comitants of  a  healthy  body. 

FOOD. 

The  selection  of  food  bears  upon  the  well-being  of  our  teeth 
through  its  local  and  systemic  effect.  Rich  and  indigestible 
food  deranges  the  digestive  tract  and  then  we  have  an  interfer- 


CARE    AND    PKEbEKVATlON    OF    IHK    IKKIH.  I7 

ence  with  nutrition.  Indigestion  and  dyspeptic  conditions 
affect  the  teeth  locally,  by  and  through  the  acid  conditions 
produced. 

Aliment  having  both  the  calorificient  or  heat-sustaining 
principles,  the  nutrient  principles  or  tissue  building,  and  the 
inorganic  or  earthy  constituents  are  necessary.  The  first  is 
contained  in  quite  sufficient  quantity  in  the  usual  food — in 
wheat,  potatoes,  milk,  Indian  corn,  sugar  and  in  most  veget- 
ables. The  nutrient  principle  is  contained  in  animal  food — 
milk,  eggs,  lean  of  beast,  bird  and  fish.  In  wheat,  rye,  beans, 
potatoes,  &c. 

The  inorganic  constituents,  forming  the  bones  and  teeth  are 
contained  in  aninial  food,  milk,  eggs  and  particularly  in  wheat, 
oats,  potatoes,  &c.  Fine  or  bolted  flour  of  which  our  white 
bread  is  made  contains  two-thirds  less  of  the  bone  constituents 
than  the  unbolted  or  that  made  of  the  whole  wheat.  The  bran, 
which  is  removed  from  the  fine  flour,  contains  seventy  per  cent. 
{lOfo)  of  bone  constituents.  In  selecting  food  for  our  children, 
we  should  bear  in  mind  that  we  want  bone  and  muscle,  strength 
and  vigor  with  only  so  much  fat  as  will  give  firmness  and 
plumpness.  It  is  then  of  the  greatest  importance  in  the  first 
years  of  infancy  and  childhood,  when  the  formative  process  is 
going  on,  that  the  parent  should  give  faithful  attention  to  the 
selection  of  food.  In  infancy,  if  the  mother's  milk  cannot  be 
had  then  pure  cow's  milk  should  be  substituted  instead  of  the 
prepared  foods:  by  adding  about  half  as  much  water  and  a 
little  cream  and  sugar  the  little  one  will  receive  a  nourishment 
similar  to  that  derived  from  the  mother;  the  casein,  earth  and 
salts  contained  therein  going  to  form  the  tissues  of  the  body, 
including  bone  and  teeth.  The  prepared  foods  largely  consist- 
ing of  the  calorificient  principle  and  lacking  in  the  others,  may 
make  the  child  fat  and  fair  yet  predisposed  to  rickets,  through 
lack  of  the  other  constituents.  The  potter  cannot  fashion  the 
bowl  without  clay,  neither  can  teeth  be  formed  without  earth. 
A  careful  study  of  our  diet  is  as  essential  to  best  results  in 


l8  CARE  AND  PRESERVATION  OF  THE  TEETH. 


point  of  health,  as  is  careful  thought  to  success  in  any  depart- 
ment of  life. 

THE  FUNCTIONS  OF  MASTICATION. 

The  importance  of  the  proper  maceration  of  our  food  is  too 
little  appreciated  and  less  often  understood.  That  nature  sup- 
plied teeth  for  the  purpose  of  breaking  up  or  grinding  our  food 
into  minute  particles,  before  it  is  passed  on  to  the  stomach,  is 
accepted  without  question;  then  why  not  properly  employ 
them?  The  saliva,  during  prolonged  mastication,  is  thorough- 
ly incorporated  with  the  aliment  ;  this  maceration  is  of  great 
importance.  First,  in  that  the  saliva  contains  a  ferment — 
ptyalin — which  digests  starches.  Secondly,  the  ingesta — food 
in  the  stomach — is  more  easily  and  thoroughly  acted  upon  by 
the  gastric  juice,  as  it  permeates  the  entire  bolus,  following 
the  course  of  the  saliva  through  the  mass,  whereas,  otherwise — 
i.  c. ,  without  proper  incorporation  of  the  saliva,  it  would  only 
act  on  the  outer  surface  of  the  bolus  of  food,  as  the  mass  would 
remain  packed  together,  a  portion  of  it  possibly  undergoing 
fermentation  before  it  could  be  acted  upon.  Soft  foods  are 
too  often  taken  into  the  mouth  and  passed  directly  to  the 
stomach  without  the  incorporation  of  the  saliva.  Persons  with 
impaired  masticating  powers  should  have  their  food  finely  cut, 
and  should  thoroughly  macerate  it  between  the  tongue  and  the 
roof  of  the  mouth.  The  teeth  require  exercise  as  much  as  the 
muscular  system ;  therefore,  the  crust  of  bread  and  other  re- 
sisting food  should  constitute  a  large  part  of  the  diet. 

PERNICIOUS  HABIT  OF  GUM  CHEWING. 

The  Author  regrets  to  learn  that  the  chewing  of  gum 
after  meals  is  recommended  by  some  practitioners  as  an  aid  to 
digestion. 


•  t:ARE    AND    PRESERVATION    OF    THE    TEETH.  1 9 

The  Author  claims  this  to  be  a  perversion  of  the  act  of  chew- 
ing. It  most  certainly  is  in  bad  taste  and  is  detrimental  to  the 
functions  of  digestion,  in  detracting  the  nerve  force  from  the 
stomach  to  the  muscles  of  mastication. 

The  time  to  chew  is  at  meal-time,  and  the  thing  to  be 
chewed  is  one's  food. 

Prolonged  mastication  is  of  paramount  importance.  (See 
chapter  on  "  The  Functions  of  Mastication.") 

Weak  digestion  is  greatly  aided  by  a  rest  of  fifteen  minutes 
before  and  after  meals,  reclining,  and  abstaining  from  reading 
and  conversation. 

Distress  in  the  stomach  between  meals  is  often  relieved 
by  the  swallowing  of  saliva.  This  is  accomplished  by  a  simple 
movement  of  the  tongue  and  cheeks  in  the  act  of  sucking  the 
saliva  back  and  forth  in  the  mouth  until  there  is  enough  to 
swallow.  This  repeated  several  times  is  sufficient,  and  is  ac- 
complished in  a  minute  or  two. 

The  properties  of  saliva  are  lubricant,  demulcent,  solvent,  di- 
gestive, (of  starches)  and  antacid,  under  normal  conditions. 

A  correct  diet,  regular  habits,  proper  exercise,  or  rest,  a 
healthy  mind,  and  a  faithful  incorporation  of  the  saliva  with 
the  aliment  is  requisite  for  maintaining  or  recovering  good 
digestion. 

PROPER  OCCLUSION  OF  THE  TEETH. 

Unless  the  teeth  in  one  arch  properly  occlude  with  the  oppos- 
ing teeth  proper  mastication  is  impossible,  and  means  should 
be  employed  to  remedy  the  defect  (see  chapter  on  correction 
of  irregularity. ) 

All  fillings  should  be  so  built  as  to  restore  occlusion :  other- 
wise the  masticating  power  is  impaired  so  far  as  the  contouring 
of  the  filling  fails  to  restore  the  said  occlusion.  This  important 
fact  is  too  often  overlooked.  We  understand  "occlusion"  to 
mean,  the  proper  contact  of  the  upper  with  the  lower  teeth 


CARE    AND    PRESERVATION    OF    THE    TEETH. 


when  the  mouth  is  closed  or  in  the  act  of  mastication.     This 
applies  to  the  molars  and  bicuspeds. 

THE  SIX  YEAR  MOLAR. 

Is  too  often  allowed  to  decay,  the  parent  thinking-  that,  be- 
cause it  is  the  first  tooth  in  the  place  (back  of  the  two  tempor- 
ary molars  and  appearing  between  the  fifth  and  sixth  year),  it 
will  be  replaced.  This  is  a  fatal  error,  and  the  loss  of  this 
tooth,  after  the  twelve  year  molar  erupts,  causes  serious  mal- 
occlusion, not  only  in  the  loss  of  the  tooth  but  also  by  the  tip- 
ping forward  of  the  second  permanent  (twelve  year)  molar.  If 
the  six  year  (first  permanent)  molar  has  been  destroyed  by  de- 
cay, it  should  be  removed  before  the  eleventh  year  that  the 
twelve  year  molar  when  it  erupts  may  occupy  its  place ;  but 
the  loss  is  a  serious  one  and  should  be  avoided. 

PRESERVATION  OF  TEMPORARY  TEETH. 

The  temporary  teeth  should  be  preserved,  with  vital  pulps  it 
possible,  until  the  coming  of  the  corresponding  permanent 
teeth.  That  the  child  may  have  perfect  masticating  powers, 
freedom  from  pain,  may  avoid  abscess  with  its  possible  serious 
sequences,  and  may  have  the  spaces  preserved  from  the  en- 
croachment of  other  teeth  adjoining,  that  the  permanent  teeth 
may  not  be  crowded  out  of  their  places.  The  preservation  of 
the  teeth  influences  the  expansion  of  the  jaw.  When  a  tooth 
is  extracted  the  adjoining  teeth  are  liable  to  take  advantage  of 
the  space  thus  created  and  occupy  a  portion  of  it,  and  in  this 
way  cause  the  crowding  referred  to.  It  is,  however,  equally 
important  that  the  temporary  teeth  should  not  remain  beyond 
the  time  of  the  eiuption  of  the  corresponding  permanent  teeth. 
If,  at  this  time,  they  have  not  been  exfoliated  they  should  be 
removed;  otherwise  the  permanent  teeth  will  erupt  inside  or 


CARE    AND    PRESERVATION    OF    THE    TEETH. 


outside  of  the  arch,  causing  deformity.  The  roots  of  the  tem- 
porary teeth,  in  normal  conditions,  are  absorbed  or  dissolved 
through  the  irritation  produced  by  the  development  and  ap- 
proach of  the  corresponding  permanent  teeth,  and  the  lime 
salts  are  again  returned  to  the  blood. 

FACE  ACHE— CAUSE. 

Face-ache,  so-called,  may  find  a  cause  in  an  irritated  pulp,* 
exposed'or  nearly  so.  Infiltration  of  sweets  and  acids,  thermal 
changes  and  pressure  acting  as  irritants.  Sensitive  dentine, 
especially  at  the  necks  of  teeth  which  have  been  denuded 
of  the  gum,  the  result  of  an  improper  use  of  the  brush,  or 
of  the  irritation  caused  by  allowing  tartar  to  remain  in  contact 
with  the  gum,  may  prove  a  cause.  Pyorrhoea  Alveolaris,  or 
the  inflammation  of  the  periosteum  of  the  root,  known  as  peri- 
ostitis, may  be  the  pathological  condition.  In  periostitis  the 
tooth  feels  longer  than  the  others  and  sore  on  tapping,  and  if 
due  to  devitalized  pvilp  ma}^  result  in  abscess  if  not  given 
prompt  attention.  A  cause  may  be  found  in  pulp  stones, 
exostosis,!  erupting  of  wisdom  tooth,  reflex  pains,  etc. 

When  pain  is  the  result  of  pulp  irritation,  dependent  on  car- 
ies, and  a  practitioner  is  not  within  reach,  relief  may  be  had 
by  the  use  of  a  medicated  pellet  of  cotton,  placed  in  the  cavity. 
But  before  using  the  cotton  it  is  necessary,  for  the  obtaining  of 
the  desired  results,  to  free  the  cavity  of  the  debris  that  the 
medicament  may  come  in  contact  with  the  dentine,  or  pulp,  if 
it  be  exposed.  The  cavity  should  be  syringed  out  with  warm 
water  of  an  alkaline  reaction,  that  it  may  neutralize  the  acid 
condition  of  the  cavity,  concomitant  with  decomposition,  and 
relie(/e  the  pulp  of  this  source  of  irritation.     The  cavit}'  is  then 

*Od()iitaliiia.  Eiiiergenc.v  Treatment  (a  criticism)  By  the  Autluir,  Medical  Record, 
November -'atli,  IWi:!. 

+Peri()steal  induction  of  the  ^Vlaxilln  Resulting  from  Exostosis  of  Tooth  Roots,  By 
the  Autlior,  .Medical  Record,  Marcli  30th,  1895. 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


dried.  Then  moisten  a  very  small  pellet  of  cotton  in  some 
obtundent,  place  it  into  the  cavity  and  gently  press  it  with  a 
dry  pellet  of  cotton  to  take  up  the  excess  of  medicament.  Too 
much  pressure  should  not  be  exerted  in  placing  the  cotton 
when  the  pulp  is  exposed,  or  when  the  dentine  over  the  same 
is  very  thin  and  easily  depressed.  A  retaining  pellet  should 
also  be  used,  dipped  in  a  solution  of  gumsandrac  and  alcohol. 
The  following  is  a  good  medicament: 

]^ 

Olei  Caryophylli,  -              -              -           3  i 

Olei  Cajuputi,          -  -             -             -      3  i 

Pulveri  Opii,  -              -              -         i3 

Camphorse,                -  -             -             -   ^^ 

Spiritus  Rectificati,  -           qs.  M.  ft.  solutes. 

ALVEOLAR  ABSCESS  (SWOLLEN  FACE.) 

This  condition  should  have  attention  at  once,  even  before 
pus  has  formed,  when  the  premonitory  symptoms  of  pain  and 
soreness  upon  pressure  on  tooth  first  make  their  appearance. 
Immediate  relief  may  be  obtained  at  any  stage  of  the  trouble. 
If  devitalized  and  putrescent  pulp  is  the  cause,  as  is  usually 
the  case,  the  mere  venting  of  the  canal  to  allow  of  the  escape 
of  gas  and  pus,  if  any  has  formed,  external  to  the  apical  fora- 
men, will  give  the  desired  result.  No  pain  whatever  accomp- 
anies this  operation.  Other  conditions  require  other  means. 
Abscess  over  superior  six  and  twelve  year  molar  teeth  is  liable 
to  cause  serious  involvement  of  the  antrum.  And  necrosis  of 
bone  may  result  as  the  sequela  of  abscess,  especially  in  the 
lower  jaw,  caries  resulting  more  frequently  in  the  upper  jaw. 

A  poultice  should  never  be  placed  on  the  outside  of  the  face, 
as  it  will  tend  to  make  the  abscess  point  and  break  externally, 
resulting  in  a  permanent  scar  upon  the  face.      Should  the  abs- 


CARE    AND    PRESERVATION    OF    THE    TEETH,  23 

cess  point  externally  it  must  be  prevented  from  continuing  its 
course  in  that  direction  by  the  application  of  cold  compresses 
or  ice  bag  externally,  and  hot  and  stimulating  applications  in- 
ternally. The  bistoury  plays  a  very  important  part  in  these 
cases.  The  applications  used  upon  the  gum  are  the  capsicum 
pad,  dental  tincture  of  aconite  and  iodine,  figs,  raisins,  hot 
water  and  soda,  etc.  Teeth  producing  these  conditions,  if 
amenable  to  treatment,  may  be  preserved  and  do  good  service 
for  many  years,  even  if  the  crowns  are  entirely  gone.  Porce- 
lain crowns  may  be  adjusted  to  the  roots ;  they  may  be  built 
down  with  metal  or  act  as  supports  for  bridges. 

SALIVARY  CALCULUS  (TARTAR.) 

Is  a  deposit  which  collects  about  the  necks  of  the  teeth.  It 
is  composed  of  the  phosphate  and  carbonate  of  lime,  mucous 
and  accidental  matter.  The  lime  salts  are  in  solution  in  the 
saliva  which  flows  from  the  many  ducts  leading  from  the  vari- 
ous glands.  Two  of  these  ducts  open  opposite  the  upper 
molars,  one  on  each  side.  Twenty  of  them  open  on  the  floor 
of  the  mouth  under  the  tongue  at  the  fraenum.  The  deposit 
should  be  removed  as  frequently  as  necessity  requires.  The 
teeth  should  be  kept  entirely  free  from  it.  The  failure  to  have 
tartar  properly  removed,  especially  that  hidden  under  the  mar- 
gin of  the  gum  is  productive  in  many  cases  of  serious  results. 
Acting  as  an  irritant  it  causes  the  loosening  of  the  gums  from 
about  the  necks  of  the  teeth,  the  absorption  of  the  alveolus, 
death  of  the  periosteum,  formation  of  pus,  loosening  and  finally 
exfoliation  of  the  teeth.  In  some  cases  pain  accompanies  this 
condition  simulating  facial  neuralgia.* 

♦Pyorrhoea  Alveolaris  Often  Diagnosed  as  Facial  Neuralgia.  By  the  Author,  Pub- 
lished in  the  Medical  Record,  February  13th,  1893. 


24  CARE  AND  PRESERVATION  OF  THE  TEETH. 

PYORRHOEA  ALVEOLARIS. 

This  is  a  disease  about  the  roots  of  the  teeth,  referred  to 
under  "Salivary  Calculus,"  caused  also  by  other  irritants  and 
systemic  influences.  This  condition  is  too  often  overlooked  in 
its  incipiency  and  the  disease  progesses  without  the  application 
of  any  remedial  effort.  There  are  very  many  sufferers  who 
never  know  the  cause  of  the  loosening  and  loss  of  their  teeth 
or  that  they  might  have  been  saved. 


RECESSION  OF  THE  GUMS. 

This  is  an  unfortunate  condition,  marring  the  beauty  that  is 
characteristic  of  a  perfect  and  healthy  gum  tissue.  Respons- 
ibility lies  with  the  improper  use  of  the  tooth  brush  or  the  per- 
mitting of  tartar  to  remain  about  the  teeth  in  contact  with  the 
gum  or  concealed  beneath  its  margin.  The  progress  of  reces- 
sion is  slow  and  the  sufferer  is  unaware  of  the  damage  being 
sustained  by  and  through  a  lack  of  knowledge  or  care,  until  it 
is  sufficient  in  extent  to  attract  attention.  The  damage  done 
is  irrepairable.  Operations  have  been  attempted,  but  the  orig- 
inal beauty  cannot  be  restored. 

SENSITIVE  DENTINE. 

Under  this  head  the  author  will  consider  only  the  sensibility 
often  found  at  the  necks  of  teeth  where  there  is  no  cavity  of 
decay.  One  or  more  teeth  may  be  involved  in  a  mild  or  to  an 
exalted  degree.  Aggravation  being  occasioned  by  cold,  sweets, 
sours  or  contact,  such  as  touching  with  an  instrument,  or  the 
finger-nail.  The  patient  often  attributes  the  pain  to  a  fancied 
cavity  of  decay,  the  tooth  being  perfectly  free  from  caries.  In 
some  cases  there  is  a  diagnosis  of  neuralgia  and  treatment 
directed  accordingly.     This  condition  of  sensibility  is  due  part- 


CARE  AND  PRESERVATION  OF  THE  TEETH.  25 

ly  to  a  recession  of  the  gum  tissue  from  about  the  neck  of  the 
tooth,  also  a  hyperacidity  of  the  system,  fluids  of  the  mouth 
or  mucous  glands,  creating  an  inflammation  or  Hypersensitive 
condition  of  the  structure.  Remedy  lies  largely  in  correcting 
the  hyperacidity.  Local  treatment  may  also  be  employed,  this 
at  the  hands  of  the  practitioner. 

EROSION  OF  THE  TEETH. 

This  is  one  of  the  most  remarkable  affections  to  which  the 
teeth  are  liable.  Its  causation  or  pathology,  as  it  is  observed 
on  the  labial  surfaces  of  the  anterior  teeth,  has  been  the  subject 
of  much  speculation,  experimentation  and  theorizing.  An  ab- 
normal secretion  of  an  acid  reaction  discharged  from  some  of 
the  labial  glands  is  accepted  as  a  cause,  in  that  in  cases  of  ero- 
sion we  find  an  enlargement  of  the  orifices  of  a  number  of  these 
glands  and  a  redness  and  vascularity  of  the  tissues  surrounding 
them.  Upon  pressure  they  can  be  made  to  exude  a  thin  watery 
fluid  distinctly  acid  in  reaction.  There  is  thought  to  be  little 
or  no  action  upon  the  tooth  structure  during  the  day,  owing  to 
the  diluent  and  neutralizing  properties  of  the  saliva,  its  neu- 
tralizing powers  lying  in  its  alkalies,  but  that  at  night  the  de- 
calcifying or  disintegrating  process  is  active  upon  the  enamel 
as  the  saliva  does  not  flow  during  sleep.  When  decalcification 
has  resulted  the  tooth  substance  yields  easily  to  the  mechanical 
action  of  the  tooth  brush.  A  condition  of  the  nutrition  with- 
out doubt  is  a  factor  predisposing  to  labial  secretions  which 
produce  the  erosion.  The  problem  which  presents,  however, 
is  a  difficult  one,  and  viewed  in  the  light  of  our  present  know- 
ledge upon  the  subject,  it  is  evident  that  investigation  must  be 
pushed  much  further  to  satisfactorily  determine  the  agencies 
which  are  at  work  in  the  perverting  of  this  labial  secretion,  and 
the  full  part  it  plays  in  decalcification.  The  lips  hold  the  se- 
cretions in  contact  with  the  teeth  at  night,   and  polish  them 


26  CARE  AND  PRESERVATION  OF  THE  TEETH. 

during  the  day.  Constitutional  or  surgical  remedies,  if  ap- 
plied, are  adapted  to  the  individual  case.  The  fact  that  a  gouty 
diathesis  seems  to  accompany  many  cases  should  be  borne  in 
mind.  The  injurious  action  of  acid  secretions,  especially  in 
cases  of  erosion,  may  be  counteracted  locally  by  the  use  of  a 
preparation  known  as  "  Phillips'  Milk  of  Magnesia,"  which  con- 
sists of  precipitated  magnesium  hydrate  held  in  suspension  in 
water.  It  is  to  be  applied  in  the  same  way  that  lime  water  or 
precipitated  chalk  is  used  for  the  purpose  of  bringing  about  the 
alkaline  condition  of  the  oral  fluids  which  neutralize  all  acids 
present.  A  teaspoonful  of  the  preparation  taken  into  the 
mouth  and  allowed  to  float  around  over  the  teeth  coats  them 
with  a  slight  film  of  alkaline  magnesium  hydrate,  which  is  suf- 
ficiently adherent  to  protect  the  tooth  surfaces  from  the  acid 
action  for  a  number  of  hours.  It  should  be  used  every  night 
before  retiring,  and  once  or  twice  a  day  when  necessary. 

GREEN  STAIN. 

Children  are  especially  liable  to  a  mucous  deposit  in  the  form 
of  a  brown  or  green  stain.  This  has  been  erroneously -called 
green  tartar.  It  is  generally  found  upon  the  labial  surfaces  of 
the  front  teeth,  more  frequently  upon  those  of  the  upper  arch 
and  is  considered  to  be  a  deposit  from  the  mucous  when  this 
secretion  is  in  a  more  acid  condition  than  is  natural.  Its  effect 
upon  the  teeth  is  most  disastrous  when  allowed  to  remain. 
The  enamel  becomes  eroded  and  the  tooth  rapidly  disintegrates. 
The  fungi  should  be  removed  as  soon  as  discovered. 

CORRECTION  OF  IRREGULARITY. 

The  correction  of  irregularities  under  favoring  conditions 
may  be  begun  and  carried  to  a  successful  termination  through 
a  wide  range  of  years.  The  most  favorable  period,  however, 
being  between  the  thirteenth  and  eighteenth  years.     As  the 


CARE    AND    PRESERVATION    OF    THE    TEETH.  27 

Operation  is  one  largely  dependent  upon  the  absorption  and 
reformation  of  bone,  and  as  the  density  of  the  bone  increases 
with  advancing  age,  so  the  correcting  process  becomes  relative- 
ly slow  and  tedious  as  the  density  increases.  Earlier  than  the 
thirteenth  year  the  operation  is  advisable  under  certain  circum- 
stances, and  later  than  the  eighteenth,  the  difficulties  increase 
with  the  years.  Correction  may  be  undertaken  as  early  as  the 
eighth  year,  and  again  successful  results  may  be  obtained  as 
late  as  the  thirty-fifth  year  or  later.  In  cases  where  a  number 
of  teeth  are  involved,  requiring  an  extensive  operation,  it 
should  not  be  undertaken  until  all  of  the  permanent  teeth  (ex- 
cept the  wisdom)  are  erupted  and  the  arch  fully  expanded, 
when,  on  examination,  it  will  often  be  found  that  the  irregular- 
ity has  much  improved  and  the  necessity  for  interference  is 
proportionately  lessened.  The  advisability  of  early  or  late  in- 
terference will  depend  upon  the  conditions,  and  early  advice 
should  be  obtained  from  a  competent  source.  The  methods 
and  appliances  are  varied,  and  there  is  much  to  be  said  of  their 
advantages  and  disadvantages.  Great  improvements  have  been 
made  in  this  direction,  but  the  operation  of  correction  in  the 
majority  of  cases  is  a  difficult  one,  calling  for  great  skill  and 
much  labor.  The  health  of  the  patient  is  of  first  importance 
in  a  case  of  projected  treatment  for  irregularity.  Constitutional 
changes,  depression  of  the  vital  forces,  as  in  debility,  schlor- 
osis,  nervous  prostration,  etc. ,  would  contraindicate  in  propor- 
tion to  the  conditions  presenting,  as  the  wearing  of  appliances 
are  irritating  to  the  nervous  system  and  a  tax  upon  the  general 
health. 

The  time  most  favorable  for  the  correcting  of  irregularities 
(thirteenth  to  eighteenth  year  of  age)  because  the  teeth  are 
fully  erupted,  is  that  period  fraught  with  important  changes 
in  the  entire  economy,  marking  the  passage  from  childhood 
into  manhood  or  womanhood,  when  the  life  forces,  especially  in 
the  case  if  the  female,  are  taxed  to  the  utmost,  the  mental 
faculties  often  overstrained  by  study,   the  physical  culture  of 


28  CARE  AND  PRESERVATION  OF  THE  TEETH. 

the  individual  neglected;  and  we  have  an  exaltation  of  the 
nervous  system  to  a  marked  degree.  Therefore  at  this  period 
of  life  should  the  vitality  of  the  patient  be  belov^'  the  average, 
no  difficult  operation  should  be  undertaken,  as  the  impairment 
to  health  might  be  serious  or  permanent.  To  overcome  in 
some  measure  the  effects  of  the  drain  upon  the  system  at  this 
period,  full  nutrition  should  be  sustained,  which  is  impossible 
if  the  teeth  have  been  made  sore  and  tender  to  the  touch  in 
the  operation  of  moving  them.  In  cases  where  the  vital 
powers  cannot  well  stand  the  strain  of  an  operation  it  is  wisdom 
to  postpone  it  or  abandon  it  altogether,  for  the  loss  of  health 
can  never  be  compensated  for  by  the  benefit  derived  from  such 
an  operation. 

FACIAL  ORTHOPEDIA. 

Is  the  correction  of  deformities  or  unpleasant  expression  of 
the  face,  to  a  graceful  contour  of  the  features,  by  means  of 
surgical  or  mechanical  interference.  The  results  obtained 
in  this  direction  have  been  truly  marvelous.  The  course  of  a 
few  months'  treatment  in  some  cases  producing  almost  a  new 
face.  In  the  movement  of  the  anterior  teeth  force  is  produced 
in  such  a  manner,  by  a  specially  devised  appliance,  that  they 
are  carried  backward  or  forward  in  a  body,  being  maintained 
in  a  vertical  positon,  to  all  appearances  carrying  the  bone  with 
them.  Example — In  a  case  of  protruding  upper  lip  and  re- 
trousse nose,  after  wearing  the  appliance  a  few  months,  which 
is  small  and  conveniently  worn,  the  upper  lip  lost  its  protruding- 
appearance,  and  the  nose  was  no  longer  retrousse.  The  face 
that  was  once  unpleasing  had  been  made  really  pretty.  Facial 
orthopedia  applied  as  described  herein  is  quite  new.  The 
Author  is  greatly  indebted  to  a  Chicago  brother  practitioner, 
the  promoter  of  this  class  of  operation,  for  instructions  in  the 
making  and  adjusting  of  the  appliance  referred  to,  and  his 
method  of  procedure,  and  to  whom  the  name  ' '  Facial  Ortho- 
pedia "  owes  its  origin. 


CARE    AND    PkliSKRVATION    OF    THE    TEETH.  29 

GOLD  CROWNS. 

The  habit  of  placing  gold  caps  or  crowns  in  the  mouth  is  car- 
ried to  the  point  of  abuse  in  many  instances.  Nature  never 
meant  that  there  should  be  a  gold  band  about  the  neck  of  the 
tooth  beneath  the  gum  margin,  and  no  matter  how  close  the 
adaptation  may  be,  the  exudation  of  the  tissues  or  the  fluids  of 
the  mouth  will  dissolve  out  a  portion  of  the  cement  and  creep 
between  the  band  and  neck  of  tooth  by  capillary  attraction.  A 
very  large  percentage  of  the  teeth  so  capped  could  have  been 
restored  to  usefulness  by  other  methods  far  more  in  keeping 
with  physiological  and  hygienic  principles.  In  restoring  the 
dental  organ  we  must  look  beyond  the  law  of  mechanics,  hold- 
ing that  as  secondary  and  in  subservience  to  the  physiological. 
Gold  crowns  placed  in  the  front  of  the  mouth  are  exceedingly 
unsightly,  in  that  the  harmony  in  color  of  the  natural  teeth  is 
rudely  broken  in  upon  and  the  beauty  of  the  whole  destroyed. 

EXTRACTION  OF  TEETH. 

The  day  has  passed  when  the  reputable  practitioner  extract- 
ed every  broken-down  and  diseased  tooth  as  the  only  alterna- 
tive. Through  the  skill  that  has  resulted  from  the  patient  ef- 
forts of  the  experimenters  and  deep  thinkers  in  the  profession, 
these  most  needed  organs  of  mastication,  though  broken 
down  and  to  all  appearances  beyond  repair,  are  restored  to  use- 
fulness and  durability,  performing  their  functions  as  though  no 
harm  had  ever  befallen  them,  though  the  conditions  are  largely 
changed.  Though  the  pulp  of  a  tooth  may  have  been  lost 
through  devitalization  consequent  upon  exposure  or  irritation 
through  the  inroads  of  caries,  or  by  other  means,  if  the  condi- 
tions within  the  canal  are,  or  have  been  made  such  as  to  pre- 
vent any  irritation  to  the  tissues  external  to  the  apical  foramen, 
the  tissues  will  tolerate  the  tooth.  The  periostium  surround- 
ing the  root  remaining  vital  and  performing  its  functions  the 


30  CARE    AND    PRESERVATION    OF    THE    TEETH. 

same  as  though  the  pulp  (nerve)  had  never  been  disturbed. 
However,  as  in  all  new  departures,  some  are  apt  to  go  to  the 
extreme  and  save  teeth  which  are  injurious  to  the  health  of  the 
possessor  and  should  be  extracted.  A  careful  differentiation 
between  those  which  may,  and  may  not  be  retained,  should 
be  exercised. 

ARTIFICIAL  TEETH. 

In  the  hands  of  a  skilled  operator  who  keeps  abreast  of  the 
times,  a  patient  may  have  the  lost  natural  organs  replaced  by 
artificial  ones,  so  perfect  in  adjustment  and  appearance  that 
the  substitution  in  many  cases  is  not  appreciable  even  to  the 
wearer.  The  porcelain  crowns  placed  upon  natural  roots,  both 
plain  and  gold  backed,  including  that  with  band,  bridges  for 
the  support  of  a  single  artificial  tooth,  or  for  an  entire  arch, 
both  permanent  and  removable,  are  the  most  perfect  substi- 
tutes for  the  natural,  except  the  implanted  tooth,  the  operation 
for  which  it  is  not  frequent.  The  majority  of  cases  proving 
ultimate  failures,  to  say  nothing  of  the  attending  dangers. 

The  Author  has  seen  failures  in  bridge  work  and  as  many 
bungling  operations,  but  when  conditions  are  favorable  and 
the  operation  properly  performed,  it  has  been  proven  to  be  the 
best  method  extant. 

Artificial  plates  supporting  teeth  still  have  their  place  and 
are  used  where  other  methods  cannot  be  employed.  Each  style 
of  plate  has  its  advantages  and  disadvantages,  only  those  in 
general  use  will  be  considered  here. 

At  the  head  of  the  list  we  have  that  known  as  continuous 
gum  made  of  porcelain  mounted  upon  a  platinum  base,  in 
which  a  perfect  representation  of  the  tissue  and  the  teeth  are 
secured.  In  addition  to  its  naturalness  in  appearance,  it  is  the 
most  hygienic  in  that  it  does  not  absorb  the  fluids  of  the  mouth, 
and  there  are  no  crevices  to  collect  the  same.     The  disadvant- 


CARE  AND  PRESERVATION  OF  THE  TEETH.  31 

age  for  the  upper  set  is  its  weight,  which,  however,  is  an  ad- 
vantage for  the  lower  set. 

Next  in  order  is  the  gold  plate.  It  is  light  in  weight,  good 
thermal  conductor,  does  not  absorb  the  fluids  of  the  mouth,  but 
more  or  less  crevices  between  the  teeth  at  point  of  union  with 
the  plate  afford  lodgment  for  a  small  amount  of  the  fluids 
which  is  beyond  reach  of  cleansing  except  the  plate  be  invested 
and  heated  to  a  point  which  burns  out  the  secretions,  and  then 
dropped  into  acid.  Where  rubber  attachments  are  used  this  is 
obviated. 

The  rubber  plate  which  is  used  more  largely  than  any  other 
is  light  in  weight,  but  is  porous  and  absorbs  the  fluids  of  the 
mouth  to  some .  extent,  and  is  non-conductile  of  the  thermal 
changes ;  this  last  propert}^  causing  a  paralysis  of  the  sensory 
nerves  of  the  tissue  covered  by  the  plate  so  that  in  cases  where 
the  tissues  degenerate  as  they  do  in  some  instances  under  the 
influence  of  the  rubber,  the  patient  is  wholly  ignorant  of  the 
fact,  there  being  no  sense  of  pain  or  soreness.  The  Author 
has  seen  some  cases  where  the  tissues  had  become  a  spongy 
mass,  blood  oozing  out  on  slightest  pressure.  He  has  made  a 
cure  in  all  these  cases,  but  one  is  reported  in  which  the  tissues 
had  become  so  greatly  degenerated  that  the  conditions  could 
not  be  relieved  and  were  of  so  aggravated  a  character  as  to 
prevent  the  wearing  of  a  plate.  Rubber  plates  may  be  lined 
with  gold  leaf  prepared  for  the  purpose.  Other  plates  such  as 
aluminum,  celluloid,  etc.,  have  their  advantages  and  disadvant- 
ages. Artificial  work  should  be  kept  perfectly  cleansed.  It  is 
better  that  plates  be  not  worn  at  night  that  the  tissues  may 
have  a  rest.  The  denture  may  be  placed  in  an  antiseptic  solu- 
tion over  night. 

ELECTRICITY  IN  DENTAL  SCIENCE. 

The  equipments  of  the  Author's  office  afford  opportunity  for 
the  appreciation  of  the  great  aid  rendered  by  and  through  the 


32  CARE  AND  PRESERVATION  OF  THE  TEETH. 


improved  electrical  appliances.  In  motor  power,  illumination 
of  cavities  and  tissues,  in  therapeutical  use  and  in  production 
of  anaesthesia.  It  is  a  fact  well  and  long  known  that  electro- 
lysis favors  the  absorption  of  remedies  by  the  skin  and  mem- 
branes, and  when  used  upon  the  tissues  within  the  mouth,  in 
combination  with  remedies  for  the  production  of  local  anaesthe- 
sia in  extracting  and  operating  upon  the  teeth,  the  success  is 
dependent  upon  the  properties  of  the  remedy  or  remedies  used. 
Remedies  favoring  pathological  conditions  as  a  result  of  their 
employment  are  as  harmful  when  applied  by  this  method  as  by 
any  other.  The  many  pathological  conditions  reported  as  the 
result  of  the  local  use  of  remedies  for  the  production  of  anaes- 
thesia, to  say  nothing  of  the  death  of  patients,  demonstrates 
the  importance  of  the  exercise  of  intelligent  judgment  and 
competency  on  the  part  of  the  practitioner.  The  Author  quotes 
from  the  Dental  Digest  of  March,  1895 :  "The  author  of  '  Legal 
Restriction  of  Nostrums'  commends  the  movement  for  the 
Legislative  prohibition  of  the  use  of  nostrums  in  extracting  or 
filling  teeth.  He  says  that  since  so  many  deaths  have  been  and 
are  almost  daily  reported  from  the  use  of  cocaine  preparations, 
it  shows  that  if  there  is  such  a  narrow  margin  of  safety  in  the 
use  of  cocaine  in  accurately  known  doses,  the  use  of  a  nostrum 
containing  cocaine  in  an  unknown  quantity  is  almost  criminal. 
Also,  that  the  plea  that  the  ethical  dentist  does  not  use  nostrums, 
does  not  relieve  legitimate  practitioners  from  obligations  to  see 
to  it  that  unprofessional  men  do  not  use  them,  since  their  use 
is  a  disgrace  to  the  whole  dental  profession." 

MEDICINE  IN  DENTISTRY. 

The  day  will  undoubtedly  come  when  every  dentist  will  be 
required  by  law  to  have  the  degree  of  "M.  D."  as  well  as  that 
of  D.  D.  S.,  or  M.  D.  S.,  the  last  two  degrees  meaning  the 
same  thing,  i.  e.,  that  the  one  on  whom  they  were  conferred 


CAKE    AND    PRESERVATION    OK     IHE    TEETH. 


had  passed  a  successful  examination  in  Dentistry.  The  degree 
of  D.  D.  S.  being  conferred  by  the  College  and  that  of  M.  D.  S. 
being  conferred  by  the  New  York  State  Censors.  The  exam- 
inations are  similar  in  both  cases,  therefore  the  employment  of 
these  two  degrees  is  a  mere  repetition.  As  the  teeth  are  so  in- 
timately connected  with,  and  are  a  part  of,  the  whole  economy, 
the  knowledge  of  medicine  is  not  only  an  advantage  in  the 
specialty  of  Dentistry,  but  will  doubtless  become  a  requisite  to 
eligibility  to  practice.  A  like  knowledge  of  Dentistry,  should 
be  imposed  upon  the  physician.  *  How  often  is  an  aching  tooth, 
especially  in  pregnancy,  extracted,  when  the  pain  does  not  call 
for  surgical  interference,  being  caused  as  in  many  cases,  by 
systemic  conditions ;  which  conditions  may  be  so  modified,  or 
changed,  by  the  use  of  the  indicated  remedy  as  to  relieve  the 
pain  which  was  but  the  expression  of  the  general  condition,  the 
derangement  of  the  digestive  tract,  or  of  some  organ.  If  one 
has  a  rheumatic  or  neuralgic  pain  in  the  arm,  the  amputation 
of  the  said  member  would  not  suggest  itself  as  a  means  of  re- 
lief, but  intelligent  medication  would  be  resorted  to.  Internal 
medication  is  also  essential  to  correct  the  constitutional  con- 
ditions responsible  for  the  perversion  of  the  secretions  of  the 
mucous  glands  of  the  mouth,  resulting  in  the  destruction  of  the 
teeth,  making  dental  operations  almost  useless  in  such  mouths 
as  the  teeth  would  continue  to  break  dov:n.  The  author  has 
produced  marked  changes  in  mouths  where  decay  had  been 
rapid,  by  and  through  systemic  treatment.  A  broad  education 
is  essential  for  best  results  in  every  department  of  human  effort, 
and  nowhere  so  important  as  in  that  which  has  to  do  with  the 
well-being  of  our  bodies. 

♦The  Common  Ground  Between  Dentistry  and  Medicine,  or  "Why  One  Should  Not 
Be  Independent  of  the  Other,  by  the  Author.  Written  for  the  Kansas  State  Medical 
Society. 


34  CARE  AND  PRESERVATION  OF  THE  TEETH. 

FIRST  DENTITION. 

As  it  would  be  beyond  the  scope  of  this  book  to  treat  of  the 
Embryology  and  development  of  the  dental  organ,  the  author 
will  not  go  further  back  in  its  history  than  the  time  of  eruption. 
The  deciduous  or  temporary  teeth  are  twenty  in  number.  The 
first  to  make  their  appearance  are  the  lower  central  incisions, 
penetrating  the  gum  at  about  the  fifth  to  the  seventh  month. 
The  next  are  the  upper  central  incisions,  erupting  at  about  the 
sixth  to  the  ninth  month.  The  lower  lateral  incisions,  erupt- 
ing on  either  side  of  the  centrals,  at  the  seventh  to  ninth 
month.  The  upper  laterals  at  the  seventh  to  eleventh  month. 
The  first  molars  at  the  eleventh  to  seventeenth  month.  The 
cuspids  (stomach  and  eye  teeth)  at  the  thirteenth  to  the  twen- 
tieth month.  Second  molars  at  the  twentieth  to  thirtieth 
month.  With  the  eruption  of  the  second  molars,  the  first 
dentition  is  completed.  There  are  exceptions  to  this  rule. 
Some  infants  have  a  few  teeth  erupted  at  birth,  and  occasion- 
ally adults  are  edentulous  (toothless)  from  birth. 

PATHOLOGICAL  DENTITION. 

As  the  derangements  of  the  alimentary  canal  and  cerebro- 
spinal system  could  not  properly  be  considered  in  this  work 
the  author  will  confine  himself  to  the  local  signs  and  symptoms. 
A  few  of  the  symptoms  of  pathological  dentition  are ;  tossing 
restlessness,  fretfulness,  feverish  thirst,  painful  paroxysms, 
exhaustion,  congestion  of  brain,  convulsions  and  emaciation. 
Death  may  result  in  severe  cases.  The  usual  local  signs  are, 
redness  and  swelling,  followed  by  whiteness  of  the  gums ;  de- 
cided flow  of  saliva  ("drooling")  desire  to  suck  thumb  or 
fingers ;  biting  the  ring  or  spoon  with  determination ;  alternate- 
ly taking  and  refusing  the  breast,  desired  upright  position  (to 
relieve  blood  pressure  in  gums).  There  are  exceptions,  when 
some  or  all  of  these  signs  are  absent. 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


35 


The  first  local  remedy  for  pathological  dentition  is  lancing, 
which  should  be  done  with  a  narrow  bladed,  curved  bistoury 
wrapped  with  muslin,  leaving  exposed  a  quarter  of  an  inch  of 
the  point,  this  of  course  should  be  done  by  a  practitioner. 
Lancing,  for  the  lower  incisions,  parallel  with  and  inside  the 
cutting  edge  of  the  teeth  and  for  the  upper  incisions  outside 
the  cutting  edge  of  the  teeth  that  the  upper  teeth  may  occlude 
outside  of  the  lower  teeth.  The  molars  are  to  be  lanced  cru- 
cially, with-  the  X-incision  liberating  the  four  cusps.  This  ap- 
plies to  the  first  and  second  lower  molars  and  the  upper  second 
molar.  The  first  upper  molar  is  to  be  lanced  with  the  (-J-)  in- 
cision liberating  the  cusps.  Occasionally  it  is  advisable  to 
remove  a  block  of  gum  in  severe  cases.  Cuspids  should  be 
lanced  similar  to  incisions  at  first.  The  immediate  dangers 
from  lancing  are,  injuring  the  enamel,  cutting  the  cheek, 
tongue  or  lips.  The  subsequent  danger  is  from  hemorrhage, 
which  may  be  swallowed  and  thus  remain  unnoticed.  To 
control  hemorrhage  give  breast  or  ring;  apply  local  remedies 
in  the  shape  of  styptics  and  the  administration  internally  of 
mild  Hemostacs.  Patient  should  be  placed  in  erect  position 
and  hot  water  applied  to  feet.  Lancing  of  the  gums  has  been 
opposed  by  some  physicians  on  the  ground  that  cicatricial  tis- 
sue, forming  after  the  operation,  is  more  dense  and  consequently 
more  resisting  to  the  erupting  tooth  and  that  internal  remedies 
should  be  given  only.  Internal  medication  most  certainly  is 
of  benefit,  but  the  Author  has  seen  such  marked  and  immediate 
relief  from  lancing,  where  internal  medication  has  failed,  that 
he  feels  the  little  sufferer  should  have  the  relief  it  affords.  Of 
course  there  is  a  proper  time  to  lance  the  gums  and  there  are 
conditions  when  it  would  be  harmful;  judgment  must  be  exer- 
cised. 


36  CARE  AND  PRESERVATION  OF  THE  TEETH. 

INFANTILE  SCORBUTUS. 

As  the  condition  of  the  gums  in  this  disease  is  often  looked 
upon  as  a  purely  local  trouble,  the  Author  deems  it  important 
to  treat  of  it  in  this  work.  The  gums  become  swollen  and 
spongy  in  appearance,  sometimes  completely  covering  the 
teeth  of  the  child.  The  color  may  be  of  dark  venous  blood 
and  bleed  easily.  The  little  one  may  be  unable  to  stand,  may 
complain  of  pain  in  the  limbs  or  will  cry  when  they  are  touched, 
being  tender,  sore  and  swollen.  There  may  be  streaks  and 
spots  that  look  like  bruises.  These  are  the  principal  manifest- 
ations that  are  but  the  local  expression  of  a  systemic  condition 
requiring  prompt  action.  The  cause  lies  in  improper  feeding 
and  is  found  mostly  in  children  fed  on  the  prepared  foods. — See 
Chapter  on  Food.  Remedy  lies  in  change  of  diet,  with  the 
employment  of  remedies  if  indicated.  A  mouth  wash  should  be 
employed.  The  food  should  be  of  fresh  cow's  milk  prepared 
in  accordance  with  the  age  of  the  child,  a  few  drops  of  Bovinine 
added  at  each  feeding,  or  the  juice  expressed  from  beef,  and  the 
juice  of  an  orange  twice  a  day,  teaspoonful  or  two  at  a  time. 
An  immediate  change  for  the  better  will  be  noted  and  recovery 
speedy. 

REFLEX  PAINS. 

Observations  establish  the  fact  that  dental  irritation  may 
give  rise  to  neuralgia  in  many  nerves,  and  more  particularly  in 
the  branches  of  the  trigeminal  or  tri  facial  nerve  itself.  This 
is  the  largest  of  all  the  cranial  nerves,  branches  of  which  supply 
the  teeth.  Through  its  wide  distribution  within  the  face 
and  over  the  head,  its  close  relation  to  other  nerves  and  to  the 
plexuses  and  ganglia  of  the  sympathetic  nerve,  it  becomes  in- 
volved in  nearly  all  the  diseases  of  the  external  portion  of  the 
head  as  well  as  the  superficial  and  deep  parts  of  the  face,  and 
occasionally  with  distant  organs  of  the  body.  By  reflex  pain 
we  mean  pain  in  a  portion  of  the  body  that  is  not  in  reality  the 


CARE  AND  PRESERVATION  OF  THE  TEETH.  37 


seat  of  the  pathological  condition.  A  most  interesting  phe- 
nomena, which  the  author  however  will  not  attempt  to  explain 
here.  Pathological  conditions  of  the  eye,  nose,  uterine  affec- 
tions especially,  and  more  frequently  disorders  of  the  alimentary 
canal  may  give  rise  to  pain  in  and  about  one  or  more  if  the 
teeth,  with  no  pain  at  the  seat  of  the  disorder  and  again  a  car- 
ious or  diseased  tooth  may  appear  to  be  wholly  inoffensive, 
but  be  the  cause  of  pain  in  the  ear,  e3^e,  face,  adjoining  teeth 
or  some  distant  organ.  Hysteria  frequently  gives  rise  to,  or  is 
associated  with  odontalgia  (toothache)  many  cases  are  cited. 
Malaria  is  productive  of  odontalgia,  and  epilepsy,  chorea,  hys- 
teria and  headache  have  been  caused  by  pathological  conditions 
in  or  about  the  teeth.  Many  of  these  cases  are  very  obscure, 
requiring  careful  examination  and  much  thought  and  research 
in  their  solution. 

In  some  cases  it  is  an  impacted  tooth  which  has  never  emp- 
tied or  other  hidden  cause  to  be  sought  for.  In  others  the 
cause  can  only  be  determined  on  post-mortem,  as  in  lesions 
within  the  cranium,  giving  no  other  evidence  but  the  reflex 
conditions. 

NITROUS  OXIDE  GAS  IN  DENTAL  SURGERY. 

N20  (laughing  gas)  is  the  safest  anaesthetic  producing  gener- 
al anaesthesia.*  In  the  constant  administration  of  gas  in  the 
Author's  practice,  he  has  never  had  an  accident  and  the  records 
show  that  when  properly  administered  there  is  absolutely  no 
danger.  N20  was  discovered  by  Piestly  in  ITTG;  first  came  in- 
to notice  as  an  anaesthetic  in  1863;  first  used  in  dentistry  by 
Horace  Wells  of  Hartford  in  1845.  Theoretical  constitution  is 
N20 — univalent  nitrogen  with  bivalent  oxygen — two  atoms  of 
nitrogen  with  one  of  oxygen,  made  by  cautiously  heating  am- 
monium nitrate  which  is  decomposed,  yielding  laughino-  o-as 


*" Nitrous  Oxide  Gas  in  Prolonged  Operations"  by  tlie  Author,  Medical  Record 
May  11th,  1895. 


CARE  AND  PRESERVATION  OF  THE  TEETH. 


and  water.  The  application  of  too  great  a  heat  produces  a  very 
poisonous  gas.  All  injurious  products  are  guarded  against  in 
the  manufacture.  When  inhaled  it  causes  exhilaration,  anaes- 
thesia and  asphyxia.  The  sensation  is  usually  one  of  agreeable 
intoxication  with  no  disagreeable  after-effects.  Sir  Humphrey 
Davy  in  1800  called  attention  to  its  anaesthetic  properties.  In 
1844  Dr.  Horace  Wells  of  Hartford,  Ct. ,  was  present  at  an  ex- 
hibition of  the  exhilarating  effects  produced  by  the  gas  upon 
those  who  inhaled  it  for  the  amusement  of  the  audience.  One 
young  man  while  dancing  around  under  the  exhilarating  influ- 
ence of  the  gas  struck  his  leg  against  the  corner  of  a  bench ; 
after  the  effects  of  the  gas  had  passed  away,  he  sat  down  and 
then  for  the  first  time  felt  a  pain  in  the  injured  leg.  Upon  ex- 
amination the  wound  proved  to  be  severe.  Dr.  Wells  asked  if 
he  had  not  felt  the  blow.  Upon  receiving  a  negative  reply  the 
doctor  remarked  that  if  so  severe  a  wound  could  be  inflicted 
without  the  knowledge  of  it,  a  tooth  could  doubtlessly  be  ex- 
tracted without  pain,  and  to  satisfy  himself  of  the  truth  of  his 
convictions,  he  had  a  brother  practitioner  extract  a  tooth  for 
him  at  his  office  the  following  day  under  gas,  and  upon  regain- 
ing consciousness  declared  that  it  was  the  greatest  thing  of  the 
age  and  said :  "I  did  not  feel  it  so  much  as  the  prick  of  a  pin. " 
This  was  two  years  before  the  discovery  of  the  anaesthetic 
properties  of  ether  by  Morton  &  Jackson  at  Boston,  and  three 
years  before  that  of  chloroform  by  Sir  J.  Y.  Simpson,  of  Edin- 
burgh. Wells  endeavored  vainly  to  have  the  profession  see  or 
realize  what  a  blessing  the  gas  w^ould  be  to  those  undergoing 
painful  operations;  but  like  so  many  other  benefactors  of  man- 
kind he  was  looked  upon  as  a  crank  and  could  make  little  or  no 
impression.  Finally,  discouraged  and  bankrupt,  he  passed  out 
of  this  life;  and  it  was  not  until  1863  that  the  gas  was  again 
brought  forward  and  has  been  used  since  that  time.  A  statue 
of  Horace  Wells  has  lately  been  erected  in  Hartford  as  a  recog- 
nition of  the  honor  due  him  as  the  discoverer  of  the  anaesthetic 
properties  of  nitrous  oxide  gas. 


CARE  AND  PRESERVATION  OF  THE  TEETH.  39 

A  FEW  INDICATIONS    FOR   THE    EMPLOYMENT    OF 

SOME  OF  THE  HOMCEOPATHIC  REMEDIES 

UNTIL  PROFESSIONAL  SERVICES 

CAN  BE  OBTAINED. 


Calcarea  Phosphorica  is  indicated  in  dentition  when  there  is 
slow  development  and  rapid  decay  of  teeth,  dental  troubles  in 
flabby,  emaciated  children  who  have  open  posterior  foulanelles, 
and  are  slow  in  learning  to  walk. 

Coffea  indicated  in  severe  pain,  stinging,  jerking  pain;  teeth 
feel  as  if  something  was  wedged  between  them.  Pain  relieved 
by  holding  cold  water  in  the  mouth.  Patients  frantic  with 
pain,  don't  know  what  to  do. 

Aconitum,  Yeratrum,  Sulphur  and  Hyascyanus  have  similar 
symptoms  and  can  be  given  when  coffea  fails. 

Belladonna,  indicated  when  tooth  and  gums  are  sore  to  pres- 
sure, worse  when  lying  down.  Boring  in  tooth  as  from  con- 
gestion of  blood.  Dryness  of  throat  or  mouth,  or  ptyalism, 
indicated  more  in  upper  front  teeth,  right  side.  Particularly 
indicated  when  pain  causes  great  restlessness,  running  about 
or  depression  of  spirits. 

Chamomilla  is  beneficial  in  many  kinds  of  toothache  espec- 
ially in  children.  Also  in  persons  who  are  frequently  vexed, 
and  who  drink  coffee ;  toothache  of  females  before  menstrua- 
tion. When  patient  is  irritable  and  inclined  to  cry,  pain  in 
decayed  teeth  after  taking  cold  when  in  a  perspiration,  worse 
during  night,  is  worse  periodically  and  unbearable,  cannot 
locate  the  tooth.  Decayed  tooth  feels  long  and  is  loose  (if  only 
appears  loose  without  being  so,  then  give  Bryonia).  When  the 
glands  under  the  chin  are  painful  and  swollen.  If  the  pain  is 
accompanied  with  great  weakness,  particularly  in  the  joints, 
&c.  If  chamomilla  gives  but  incomplete  relief,  compare  Anti- 
monium  Crudum  and  Mercurius. 


40  CARE  AND  PRESERVATION  OF  THE  TEETH. 

Nux  MoscHATA  is  excellent  for  children,  and  women  during 
pregnancy,  and  people  with  cool  dry  skin,  who  do  not  easil}' 
perspire.  Pains,  the  result  of  taking  cold  in  cold  damp 
weather  or  night  air,  when  warm  applications  ease  the  pains, 
which  are  worse  in  the  air  and  in  cold  damp  air  if  drawn  into 
the  mouth.  Pain  may  commence  on  right  side  and  go  to  the 
left;  as  if  tooth  were  being  wrenched  out  (Nux  Vom.  Ipeca- 
cuanha).    Worse  by  motion  in  going  up  or  down  stairs. 

Nux  Vomica  for  persons  of  ruddy  complexion,  hasty  temper, 
who  indulge  in  spirits  and  coffee,  who  have  taken  cold  or  have 
little  out-door  exercise.  Pain  digging,  jerking  or  rheumatic 
tearing  or  as  if  wrenched  out  (arnica  and  mercurius),  when 
healthy  tooth  pains  and  feels  loose,  or  seems  too  long. 

Pulsatilla  is  most  suited  to  persons  of  quiet,  timid,  mild 
dispositions.  Want  to  lean  up  against  something  or  somebody, 
cry  easily,  pain  only  on  one  side,  with  earache  and  headache, 
stinging  pain  in  decayed  tooth,  painfulness  of  left  side  of  face 
extending  to  the  ear  with  heat  and  chills  over  whole  body. 
Throbbing,  jerking  or  pricking  pain,  pain  aggravated  by  cold 
water,  warmth  of  room,  or  heat  of  bed,  relieved  by  drawing 
cold  air  into  the  mouth  or  in  the  open  air,  but  returns  in  the 
warm  room.  Worse  when  sitting;  better  when  walking  about 
worse  toward  evening. 

Ignatia  is  indicated  where  patient  grieves  much,  having 
symptoms  of  the  foregoing  remedies.  Tender,  sensitive,  sad 
disposition.  Teeth  feel  as  if  crushed ;  worse  after  smoking  or 
drinking  coffee,  after  dinner,  in  the  evening,  after  lying  down, 
and  in  the  morning. 

Hyoscyamus,  when  pain  almost  drives  patient  mad.  Sensi- 
tive, nervous,  excitable  persons ;  tooth  feels  as  if  coming  out, 
is  loose.  Buzzing  pain.  Throbbing,  which  extends  to  fore- 
head, flushes  of  heat,  with  flow  of  blood  to  the  head.  Comes 
on  in  morning.     Pain  caused  by  cold  air. 

Mercurius. — Pain  affects  whole  side  of  face,  drawing  and 
stinging    pains    extend   to   ear,    or   sensation    of   tooth   being 


CARE  AND  PRESERVATION  OF  THE  TEETH.  41 

wrenched  out.  Mercurius  is  frequently  suitable  for  children, 
and  in  general  for  toothache  in  decayed  teeth.  Teeth  are 
almost  always  loose.  The  gums  swell  and  become  white  and 
ulcerated ;  face  and  upper  lip  may  be  so  swollen  that  recogni- 
tion is  difficult. 

Hepar  is  beneficial  after  Belladonna  and  Mercurius,  when 
the  swelling  of  the  gums  continue.  Pain  worse  at  night  after 
eating,  and  in  warm  room.  There  may  be  throbbing  pain  as  if 
blood  is  being  forced  into  the  tooth. 

Carbo  Veg.  is  useful  sometimes  when  mercurius  or  arseni- 
cum  give  some  relief.  For  persons  who  have  taken  calomel  to 
excess,  especially  when  the  gums  are  separated  from  the  teeth 
and  bleed.  Teeth  ache  when  touched  b}^  the  tongue,  loose 
and  ulcerated  teeth. 

Bryonia  for  hot-headed,  obstinate,  irritable  and  passionate 
people.  Pain  is  usually  in  healthy  teeth ;  occasionally  in  de- 
cayed ones.  Pain  aggravated  by  smoking  or  introducing  any- 
thing warm  into  the  mouth.  Better  in  the  open  air.  Decayed 
teeth  are  worse  in  contact  with  air.  Teeth  feel  too  long  and 
loose.  Better  when  lying  on  affected  cheek,  but  worse  when 
lying  on  the  other. 

Staphisagria  is  indicated  when  the  teeth  become  black  and 
decayed  and  scale  off,  the  gums  white,  ulcerated,  swollen  and 
throbbing,  painful  on  touch,  and  covered  with  ulcers  and 
blisters.  Pain  worse  in  open  air  and  from  cold  drinks,  aggra- 
vation during  night  and  toward  morning. 

Phosphoric  Acid  for  swollen  and  bleeding  gums,  burning 
in  front  teeth  during  the  night.  Decayed  teeth  causing  pain. 
Sensation  as  if  they  would  be  forced  out,  worse  in  bed  when  warm. 

Lachesis. — The  gums  are  bluish-red  or  swollen  and  bleed 
easily,  and  pain  extends  down  into  the  throat;  headache  over 
eyes.  Decayed  teeth  are  painful.  Congestion  of  blood  to  the 
head.  Throbbing,  jumping,  boring  into  the  jaw  bones,  decay- 
ed teeth  too  long.  Chill  fever  and  thirst.  For  melancholic  or 
choleric  persons. 


42  CARE    AND    PRESERVATION    OF    THE    TEETH. 

Calcarea. — Indicated  in  pains  in  decayed  teeth  and  around 
loose  stumps.  For  toothache  in  pregnant  women,  when  gums 
are  sensitive  and  swollen.  Continuous  pain  in  loose  teeth 
caused  by  taking  cold,  cold  air  and  noise  aggravates.  Neither 
warm  or  cold  drinks  are  tolerated. 

SiLiCEA. — For  fistulous  openings  on  the  gum  discharging 
offensive  matter.  For  weak  and  intollerant  tissue.  Pain  in 
the  bones  of  the  face  spreads  over  the  whole  cheek,  boring, 
tearing  pain. 

Arnica. — Is  indicated  for  the  stopping  of  hemorrhage  after 
extraction  of  teeth  and  it  favors  rapid  healing  of  the  gum. 
Five  drops  of  the  tincture  should  be  mixed  with  a  half  tumbler 
of  cold  water  and  used  as  a  mouth  wash  after  extraction  or 
other  dental  operations  or  when  a  new  plate  causes  pain  and 
swelling  of  the  soft  parts. 

For  Flow  of  Saliva,  Trif ;  If  very  offensive,  mere,  sickening, 
colch. ,  ipec. ,  Iris  V. ;  When  sleeping  if  wet  pillow,  mere. , 
with  yellow  saliva,  nit.  ac. 

For  bloody  saliva,  mere. ,  nit.  ac. ,  nux  v.  ;  If  frothy,  * '  like 
cotton  "  coc,  nux  m.,  pul.,  or  if  ropy,  hyd.,  kali  bic. 

For  Foul  Breath,  kali  phos.,  kre.,  mere;  as  from  spoiled 
eggs,  arn.  ;  or  old  cheese,  aur.  ;  musty,  alu.,  kali  bich.,  led.  ; 
urinous,  graph. 

Ulcers  in  the  mouth,  hyd.,  kali  bich.,  mere,  prot.  gangren- 
ous, ars.,  lach.,  sec.  ;  From  mercury,  kali  iod. ,  nit.  ac,  phyt. 

Nausea  and  vomiting  of  pregnancy ;  if  in  morning,  aster,  24 
evening,  kre.  ;  Any  time,  Ipec.  IX,  drop  dose.  Pepo  tinct.  five 
drops  before  meals.  Chloroform  one  drop  in  hot  water.  Lie 
down  with  hips  higher  than  head. 

IcHTHYOL. — For  local  pain.  Local  redness,  inflammation, 
neuralgia,  abscess,  boil,  bruise,  burn,  scald,  ulcer,  tumor:  apply 
Ichthyol  pure,  or  fifty  per  cent,  ointment;  or  for  moderate 
strength,  Ichthyol,  one  part,  water  four  parts  and  Lanoline  five 
parts,  mix  and  apply. 


CARE  AND  PRESERVATION  OF  THE  TEETH.  43 

Internally  take  two  gr.  pills  several  times  a  day  for  any  pain 
from  any  cause. 


Bismuth  Sub.  Nit. — Dust  on  affected  part.     For  sore  mouths, 
ulcers,  &c. 


For  apthae  and  ulcers. 
1^ 


Glycerine,  -  -  ?  i 

Acidi  Carbolici,  -  -  3  i 

Sodae  Sulphitis,       -  -  3  i 


Aqua,  -  -  -  3  X  M. 

Sig. — Use  as  mouth  wash  or  by  means  of  an  atomizer. 

For  soreness  or  tenderness  about  root  on  pressing  tooth. 

Tr.  Capsicum,         -         .         .         i  part. 
Vin  Opii,     -         -         -         -         -    2  parts  M. 

Sig. — Apply  to  gum  on  cotton,  felt  or  blotting  paper  of  size 
sufficient  to  cover  the  affected  part.  The  cheek  may  be  pro- 
tected by  a  small  piece  of  oiled  silk,  waxed  paper  or  thin  rub- 
ber ;  which  may  be  stitched  to  the  blotting  paper  or  cotton. 

ACONITE  AND  IODINE. 

Iodine  Tinct.  officinal,  -  2  parts. 

Aconite    "  "  -         -      i  part  M. 

Sig. — Dry  the  gum  and  then  paint  it  with  a  small  amount 
on  very  small  piece  of  cotton  wound  on  the  end  of  a  match  or 
small  stick.  Hold  the  cheek  away  until  it  dries.  The  tincture 
used  in  dentistry  is  stronger  than  the  officinal. 


44  CARE    AND    PRESERVATION    OF    THE    TEETH. 

DENTIFRICE  FORMULAE. 

Chalk  precipitated  (not  prepared)  -  f  xlv. 

Orris  pulv.    -  -  -  -  -     3  viii. 

Sapo  cast  -  -  -  -  1  xii. 

Ossepia  -  -  -  -  -     j  ii- 

Saccharin  -  -  -  -  3  i. 

Carmine  No.  XL  (optional)  -  -     3  ss. 

Oleum  Rosa         .  .  .  -         Gtt  L 

Gessamine  Ess.         -  -  -  -     3  ss. 

M.  and  pass  powder  through  a  No.  40  sieve  and  then  through 
a  No.  80  sieve. 

Sig. — Use  on  the  brush  in  cleansing  and  polishing  the  teeth. 


Chalk  precip.        -  -  -        |  XX 

Orris  pulv.     -  -  -  3  ii. 

Saccharin  -  -  -       Gr  XV 

Sapo  cast        .  -  -  3  iii. 

Oil  Wintergreen,  -  -       Gtt  XXX 

M.  and  pass  through  sieve  No.  40  and  then  through  a  No.  80 
sieve. 

Sig. — Used  on  brush,  &c. 


CARE    AND    PRESERVATION    OF    THE    TEETH.  45 

INDEX. 

Page. 

Alveolar  Abscess  (Swollen  Face)  Remedy  and  Dangers  22 

Artificial  Teeth 30 

Choice  of  a  Brush       ........  12 

Correction  of  Irregularity       ......  26 

Disintegration  of  Teeth  in  early  Motherhood 

preventive  treatment            ......  8 

Dentifrice        .........  13 

Electricity  in  Dental  (Science     ......  31 

Erosion  of  the  Teeth '25 

Examination  of  Teeth        .......  13 

Extraction  of  Teeth 29 

Face-Ache — cause      ........  21 

Facial  Orthopedia 28 

First  Dentition            ........  34 

Floss  Silk 12 

Food — careful  selection  essential  to  best 

physical  results  .          .          .          .          .         .         .16 

Gold  Crowns — their  abuse      ......  29 

Green  Stain — Importance  of  prompt  removal    .          .  .26 

Hygiene          .........  14 

Infantile  Scorbutus    ........  36 

Indications  for  Remedies  and  Formulae         .          ,          .  39-44 

Local  Conditions  Favoring  Decay               ....  9 

Medicine  in  Dentistry     .......  32 

Mouth  Wash 13 

Nitrous  Oxide  Gas  in  Dental  vSurgery    ....  37 

Pathological  Dentition        .......  34 

Pernicious  Habit  of  Gum  Chewing          ....  IS 


46  CARE    AND    PRESERVATION    OF    THE    TEETH. 

INDEX.  —Continued. 

Page. 
Pyorrhoea  Alveolaris  causing  loosening  and  loss  of  teeth  2i 

Physical  Exercise — its  importance     .....        16 

Preservation  of  Temporary  Teeth  ....  20 

Proper  Occlusion  of  the  Teeth  .  .  .         .  .10 

Recession  of  the  Gums  .  .          .          .  .      -  .         .  24 

Reflex  Pains       .  .  .  .  .  .  .         .  .        3» 

Salivary  Calculus  (Tartar).     Why  it  should  be  removed  23 

Sensitive  Dentine       .  .          .  .          .  .          .  .24 

Systemic  Conditions  predisposing  to  decay  ...  9 

Theory  of  Caries,        ........  7 

The  Proper  Use  of  the  Tooth  Brush  (vs.  its  abuse)        .  11 

The  Tooth  Pick 12 

The  Glass  Tube  (its  fallacy)  .......  14 

The  Function  of  Mastication  .....       18 

The  Six  Year  Molar 20 


LISTERINE 


FOR  THE  CARE  OF  THE  TEETH. 

EONSTANT  care  and  watchfulness  is  requisite  to  maintain  even  an 
approximation  to  tliat  degree  of  cleanliness,  so  necessary  for  the 
preservation  of  the  teeth  and  for  the  maintenance  of  a  healthy 
condition  of  the  gums  and  Hning  membrane  of  the  oral  cavity.  The 
particles  of  food  which  find  ready  lodgment  in  the  interstices  of  the 
teeth  and  in  the  tooth  structure  (forming  a  most  suitable  pabulum  and 
very  secure  habitation  for  the  multiplication  of  micro-organisms),  rap- 
idly degenerate  into  fermenting  and  putrefying  substances  and  gases, 
highly  destructive  to  the  tooth  structure  and  deleterious  to  the  soft 
part  and  to  the  general  health. 

LISTERINE  is  invaluable  for  the  care  and  preservation  of  the  Teeth;  it  prom 
ptly  destroys  all  odors  emanating  from  diseased  gums  and  teeth,  and 
imparts  to  the  mucous  surfaces  a  sense  of  cleanliness  and  purification; 
used  after  eating  acid  fruit,  etc. ,  it  restores  the  alkaline  condition  of  the 
mouth  necessary  for  the  welfare  of  the  teeth,  and  employed  system- 
atically it  will  retard  decay  and  tend  to  keep  the  teeth  and  gums  in  a 
healthy  state.  Listerine  is  valuable  for  the  purification  of  artifical 
dentures  and  for  the  treatment  of  all  soreness  of  the  oral  cavity  result- 
ing from  their  use.  Patients  wearing  bridge  work  should  constantly 
employ  a  Listerine  wash  of  agreeable  strength. 

Listerine  is  used  in  various  degrees  of  dilution;  one  to  two  ounces 
of  Listerine  to  a  pint  of  water  will  be  found  sufficiently  powerful  for 
the  general  care  of  the  deciduous  teeth  of  children,  whilst  a  solution 
composed  of  one  part  Listerine  and  three  parts  water  will  be  found 
of  agreeable  and  thoroughly  efficient  strength  for  employment  upon 
the  brush  and  as  a  daily  wash  for  free  use  in  the  oral  cavity,  in  the 
care  and  preservation  of  the  permanent  teeth. 


LITERATURE  DESCRIPTIVE  OF  LISTERINE  MAY  BE  HAD 
UPON  APPLICATION  TO  THE  MANUFACTURERS, 

LAMBERT  PHARMACAL  COMPANY, 

ST.  IvOUIS,  PvIO. 


Why   use  Pond's   Extract  ?  1 

Why  not  something  else  ? 
Because— 

Dr.  J.  J.  Thomas  says:  "It  is  incomparably  supe- 
rior to  any  extract  of  Hamamelis  I  have  ever  used. " 

Dr.  O.  G.  Randall  says:  "Nothing  can  equal 
Pond's  Extract.  I  have  tested  others,  and  yours  is 
four  times  as  strong  as  the  best." 

Dr.  J.  C.  MiTCHiB  says:"Pond'sExtract  of  Hamam- 
elis Virginica  is  the  only  reliable  article  I  have  found. " 

Dr.  H.  K.  WEiLERsays:  "The  difference  between 
Pond's  Extract  and  so  called  Witch  Hazel  is  the  dif- 
ference between  a  cent  and  a  dollar. " 

Dr.  H.  F.  Merrill  says:  "It  is  far  superior  to  any 
I  have  used  in  strength  and  purity." 

Dr.  R.  J.  Harrison  says:  "I  have  never  found 
any  extract  equal  to  Pond's. " 

And  numerous  others  of  similar  purport. 

No  proprietary  article   on   the  market  is  so  much   imposed  upon   as 

Pond's  Extract;  but  the  poor  quality  of  Witch  Hazel  being  manufactured, 

and  the  poor  results  obtained  by  using  it,  are  fast  educating  the  public 

to  buy  the  genuine  article.— TnE  Western  Druggist. 

And  that's  ^why  I 


PODl'S 

Eilract 


Is  invaluable  for 
Wounds,  Cuts, 
Bruises,  Sore  Feet. 
LameMuscles  also 
for  Sore  Throat, 
Hoarseness,  R  li  eu- 
matism,  Inflam- 
mation, and  Hem- 
cirrhages.    .    .    . 

Accept  nothing  as 

"Just  as  good." 

Pond'sCxtract  cures, 

imitations  do  not. 


P 


ond's  Extract 

COnPANY, 

J^  76  Fifth  Avenue, 
NEW  YORK. 


Acidity  of  the  mouth  means  destruction  to  the  teeth. 

To  correct  this  condition  chalk,  bicarbonate  of  soda,  lime  water,  etc. 
have  been  used,  but  are  inefficient,  irritating  and  disgusting. 
A  teaspoonful  of 

PHILLIPS'  MILK  OF  MAGNESIA 

[A  Pure  Hydrated  Oxide  of  Magnesium.— (MgH202.)  Fluid.] 

taken  into  the  mouth  and  thoroughly  rinsed  about,  will  be  found 
Pleasant,  Harmless  and  Effective.  It  should  be  employed  at 
least  twice  daily  and  especially  on  retiring,  as  decay  goes  on  more 
rapidly  during  sleep. 

Teeth  sensitive  to  heat,  cold,  or  the  touch,  indicate  an  acid  condition. 

Ask  your  dentist  about  Phillips'  Milk  of  Magnesia. 

BEWARE  OF  IMITATIONS.  Insist  on   PHILLIPS'. 

THE  CHAS.  H.   PHILLIPS  CHEMICAL  CO.,  77   Pine  St.,  New  York. 


-^f; 


H 


OMOEOPATHIC 

Medical  Cases 


Boericke, 
Runyon 

Ernesty, 

497  Fifth 
Avenue, 

Below  42d  St., 
New  York. 


M 

m 


Filled  Foi<  Families. 

HOMOEOPATHIC  MEDICAL 

BOOKS  FOR  FAMILY 

USE. 

HOMOEOPATHIC  REMEDIES  IN 
ALL   THE   POTENCIES. 

pfGScri|Diions  (^arefully  S) 
aAccuraiely  (ompoundGd. 

PUBLISHERS    OF 

edical  vr  |jiterature. 


J? 


i  HOMOEOPATHIC  MEDICAL  SUPPLIES, 
f  SURGICAL  INSTRUMENTS,  X-. 


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